The four different
types of ACA plans

All ACA plans are mandated to cover 10 essential benefits. Factors such as your budget, where you live, and the kind of health care you require are important to consider when choosing from ACA plans. All ACA plans are also eligible for government subsidies.
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PPOs

Preferred Provider Organization

Preferred Provider Organization plans, also called PPOs, are one of the most popular plan types for individuals and families. PPOs allow you to visit whatever in-network health care provider you’d like without requiring a referral from a primary care provider.
In-network care will be covered at a higher benefit level than any care you receive out-of-network.
You can expect PPO plans to require you to pay an annual deductible before the insurance company kicks in. Additionally, you may also have a co-pay (according to eHealth, co-pays are usually around $10-$30) or coinsurance that you have to pay for certain health care services.
A PPO plan may be the right ACA plan for you if:

  • You want to freedom to choose almost any medical facility or provider for your needs
  • You want some coverage if you choose to go out-of-network
  • You don’t want to have to receive a referral first from your primary care provider in order to see a specialist
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POSs

Point of Service Plans

A Point of Service Plan, or POS, has some qualities of an HMO and PPO with benefit levels depending on if you receive care in or out-of-network. You can think of a POS plan as a sort of HMO/PPO hybrid.
Similar to an HMO plan, with a POS plan you will have to designate a PCP who will make referrals to in-network specialists when you require it. Typically services received through your PCP are typically not subject to a deductible or preventative care benefits are usually included.
Similar to a PPO plan, you may receive care from providers who are out of your provider network but with greater out of pocket costs. You may also be responsible for paying a co-pay, coinsurance, or an annual deductible.
A POS plan may be the right ACA plan for you if:

  • You are willing to coordinate your care through your designated primary care physician
  • Your preferred doctor participates within the plan network
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HMOs

Health Maintenance Organization Plans

HMO, or Health Maintenance Organization, plans offer a wide range of healthcare services through a network of providers who agree to supply these services to members. You’re likely to have coverage for a broad range of preventative healthcare services than you would through another plan.
As of 2018, HMOs have emerged as the most popular aca plan amongst eHealth shoppers. According to a recent study, 53% of shoppers selected an HMO plan in 2017.
You will be required to choose a primary care physician (PCP) who will take care of most of your health care needs. Your PCP will need to refer you to a specialist if you decide you want to see one.
While HMOs typically have lower out of pocket costs, you may be required to pay a deductible before your coverage starts but your co-pays will likely be minimal. Keep in mind that with an HMO you will likely have no coverage for any care you receive out-of-network or for services you receive without a proper referral from your PCP.
A HMO plan may be the right ACA plan for you if:

  • You’re shopping for an ACA plan with a low monthly premium
  • You want an ACA plan with little or no deductible and don’t mind having an out-of-pocket limit
  • You need preventative care services
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EPOs

Exclusive Provider Organization Plans

With an Exclusive Provider Organization plan, or EPO, you may exclusively use the care providers – this includes doctors, specialists, and hospitals – within the plan network, but you cannot go out-of-network and receive coverage.
An EPO plan may be the right ACA plan for you if:

  • You do not want to have to get a referral to see a specialist
  • Your preferred providers are in-network
  • You want to receive a much lower negotiated monthly premium than what you would get with an HMO or a PPO plan
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